Effect of electroencephalography-guided general anesthesia on postoperative delirium : A meta-analysis of randomized controlled trials.

BACKGROUND: Postoperative delirium (POD) is a common and serious complication. Electroencephalography (EEG)-guided anesthesia has been proposed as a method to minimize excessive depth of anesthesia and potentially reduce the incidence of POD. OBJECTIVE: This study was conducted to evaluate the effect of EEG-guided anesthesia on POD incidence. METHODS: To identify relevant trials a comprehensive search across several electronic databases was performed. The primary outcome was the incidence of POD, while secondary outcomes included duration of EEG suppression and postoperative cognitive dysfunction (POCD) at 1 week and between 1 and 3 months postoperatively. Pooled relative risk (RR) and standardized mean difference (SMD) were calculated. RESULTS: A total of 18 studies were included in the analysis. The results showed that EEG-guided anesthesia significantly lowered the incidence of POD (RR: 0.77, 95% confidence interval, CI: 0.64-0.92; p = 0.0046), demonstrating a protective effect. Additionally, EEG-guided anesthesia resulted in a significant reduction in the duration of EEG suppression (SMD: -0.57, 95% CI: -0.90 to -0.25; p = 0.0005). For POCD, no significant effects were observed at 1 week (RR: 0.54, 95% CI: 0.19-1.51) or at 1-3 months postoperatively (RR: 0.49, 95% CI: 0.20-1.18). CONCLUSION: The use of EEG-guided anesthesia was associated with a decrease in the incidence of POD and a significant reduction in the duration of EEG suppression; however, its impact on preventing POCD was limited. These findings suggest that although EEG-guided anesthesia can help minimize excessive depth of anesthesia, further research is necessary to identify additional strategies for reducing POD and improving long-term cognitive outcomes.